Treadmill Turmoil; Stretching and Strengthening Exercises for the Hip Flexors and Extensors (Runner Hip Weakness and tightness, Hip Flexor, Piriformis, TFL, Quad, Glute, Hamstring Stretch)

Treadmill VS outdoor running

The weather is warming up, but we’re not in the clear yet! By now, training has commenced for anyone who is planning to race this spring season. Have you had to move your workout inside over the winter months?

There are many variables that come with running outside. From potholes to uneven ground, the streets of Philadelphia offer many changes in terrain! Elements such as wind or rain will add an extra challenge to your run, while snow or ice adds caution to your footing. Obstacles such as pedestrians, traffic (and traffic lights) and construction stimulate the mind, prompt a stop/start response and will also impact stride length, cadence and speed. A treadmill workout eliminates the variety in each step; running on the same belt at the same speed can cause some muscles to overwork and some to not work at all. Whenever possible, take advantage of the programs available on the treadmill to mix up your workout.

Environmental variety aside, muscle activation is much less efficient on a treadmill than when running on solid ground [1]. Considering that the belt moves below the runner, the need to push off and propel forward is eliminated (the ground moves below the runner, rather than the runner moving over ground). As such, hip extension becomes passive; the belt drags the leg backwards under the runner rather than the Hamstrings and Glutes firing to push the runner forward over the ground. The less efficient use of the posterior muscles (Glutes and Hamstrings) places a greater strain on the anterior muscles (Quads and Hip Flexors). The runner is now forced to lift the leg forward and extend the knee, firing the Quads and Hip Flexors. Research has also shown that runners have a shorter stride length and a greater stride frequency when running on the treadmill [5], meaning that the posterior leg reaches a shorter range of extension, and the muscles of the anterior leg work at a faster rate.

Due to the change in biomechanics, strengthening the hip extensors and stretching the hip flexors is an essential supplement to treadmill training.

Stretching and Strengthening Exercises for the Hip Flexors and Extensors

Dynamic Stretching

A dynamic stretch involves stretching while moving. When one muscle group is stretching, its antagonist group (the group responsible for the opposing movement) is contracting/strengthening. A dynamic stretch is a great way to warm up the muscles before a workout or before static stretching.

Cat/Cow Variation

Position yourself on the floor on your hands and knees. Bring one knee towards your nose, tucking your head down between your shoulders. (This position is contracting the Hip Flexors, yet stretching the Glutes). Reverse the exercise by extending your leg out behind you, straightening your knee, lifting your foot as high as you can, and arching your back to looking at the ceiling (this position is stretching the Psoas and Quads, yet contracting the Glutes).

Forward Leg Swings

Hold on to something for support. Kick your leg forward as far as you can, then let your leg swing back behind you. As you stretch, your range of motion should increase. When kicking forward, your leg is stretching the Hamstrings and Glutes yet contracting the Quads and Psoas. When kicking behind you, you are contracting the Glutes and Hamstrings, yet stretching the Quads and Psoas.

Lateral Leg Swings

Hold on to something for support. Kick your leg out laterally, engaging the Glute Medius/Minimus and TFL. Let the leg swing back across the front of your body, stretching the Glute Medius/Minimus and TFL. As you stretch, your range of motion should increase.

Flexors

Psoas

The Psoas works in conjunction with other muscles to help you lift your leg in front of you, turn your foot out to the side and bend your lumbar spine to touch your toes. It also joins forces with the Iliacus to create the Iliopsoas, the ultimate spine stabilizer and the reason you can keep a steady warrior pose in yoga practice!

Strengthening: crunch; laying on the back, flex the hip of the exercising side to pull the knee toward the chest with both hands. Engage the core, release the grip of the hands while maintaining the crunch position. Hold for five seconds, then lower and release.

Stretching: Flex the hips to lean the trunk forward. Place the knee of the exercising leg on a surface such as a couch, low table or chair. Slowly extend the hips, bringing the trunk to a neutral position. To increase the stretch, flex the knee of the exercising leg.

Piriformis

The Piriformis is located deep to the Gluteals. The rope-like muscle is attached to your Sacrum and the Femur, and is one of the six muscles that are responsible for lateral rotation the hips.

Strengthening: Side-lying clamshell; lay on one side with hips and knees flexed. While keeping the feet together, engage the Quads and Glutes to rotate the top hip, pointing the knee to the ceiling. Hold for five seconds, then lower and release [2].

Stretching: Number 4; Lay on the back, firmly plant the foot of the resting leg on the ground by the glute. Loosely cross the exercising leg over the planted leg so that the ankle rests just above the knee. Flex the hip of the resting leg and bring the resting knee towards the chest.

Tensor Fascia Latae

The TFL is a small muscle located on the outside of the upper leg that attaches to the IT Band. The TFL is responsible for hip flexion when you squat or pedal a bike, the medial rotation of a breaststroke kick, and abducting the hip when you bust out a karate kick!

Strengthening: Lateral stepping with resistance; place a resistance band around the ankles. Carefully step laterally towards the exercising side, the opposite leg then follows to bring the feet together.

Stretching: Lay on the back with arms at shoulder height. Flex the hip of the exercising side so that the leg comes to a 90-degree angle, maintain a straight leg. Lower the leg to the hand on the opposite side.

Quadriceps Muscle Group

The Quads are the four large muscles found on the front of the upper leg. All four muscles are responsible for knee extension, like when you kick a soccer ball. The Rectus Femoris is the only quad muscle that crosses both the hip and the knee joint, therefore it is the only Quad that assists in hip flexion.

Strengthening: Straight leg raise; lay on your back with legs extended. Whilst maintaining a straight leg, engage the exercising leg and slowly raise it to a 45-degree angle, hold for five seconds and then lower it to the ground. *In the instance of strengthening the hips, a straight leg will engage the Rectus Femoris (hip flexor).

Stretching: Lay prone on the ground. Wrap a band around the foot of the exercising leg, hold the end of the rope over the shoulder. Flex the knee and bring the foot to the glute. Use upper body strength to pull on the rope for a deeper stretch.

Gluteus Medius and Minimus

The Gluteus Minimus muscle is located deep to the Medius. Both muscles are responsible for hip flexion, medial rotation and abduction of the hip. The Medius is unique in that it has both anterior and posterior fibers, therefore similar to the deltoid in the shoulder, it is able to conduct the opposing movements of flexion and extension!

Strengthening: Fire-hydrant; start on all fours. Maintaining a 90-degree angle of the knee, engage the exercising side and laterally flex (abduct) the hip so that your knee is pointing to the wall beside you… like a dog marking its territory! Hold for five seconds, then lower and release [2].

Stretching: Lay on the back, firmly plant the foot of the exercising leg on the ground by the glute. Tightly cross the opposite leg over the planted leg. Use the opposite leg to draw the exercising leg laterally towards the opposite side.

Extensors

The Gluteus Maximus and Medius

Along with the Medius and Minimus, the Maximus assists with abduction of the hip. However, as the fibers of the max attach to the posterior of the femur, they oppose the Minimus and instead of flexing the hip, they extend it. The Maximus is the primary force in stair climbing!

Strengthening: Bridge; lay on back with feet planted on the ground by the glutes. Engage the Quads and Glutes to slowly raise the pelvis. Hold for five seconds, and then lower and release.

Stretching: Stabilize pelvis, flex the knee and hip of the exercising leg and move leg across to opposite side chest, place both hands on lateral side of the knee to assist.

Hamstring Muscle Group

The Hamstring group consists of three long muscles on the posterior of the upper leg. The three muscles cross both hip and knee joints, and are responsible for extending the hip and flexing the knee; as in flutter-kick when swimming freestyle.

Strengthening: Lay prone with a resistant band around your ankles. Maintaining a straight leg, engage the exercising side and extend the hip, raising the leg in the air. Hold for five seconds and then lower and release.

Stretching: laying on back, take a rope around the foot of the exercising leg. Maintaining a straight leg, flex the hip to raise the leg into the air. Use upper body strength to pull on the rope for a deeper stretch.

If you have had to take to the treadmill these winter months now you know why your technique may seem out of balance. The Sports Massage Specialists at Phila Massages will focus on massaging your overworked and tired flexors and will assist you with stretching your underworked and tight extensors. Phila Massages will have you on the road again faster than you can say Willie Nelson!

Related articles:

http://www.philamassages.com/blog-1/the-elusive-psoas

http://www.philamassages.com/blog-1/piriformis-syndrome-what-a-pain-in-the-butt

http://www.philamassages.com/blog-1/gluteus-a-travel-companion

http://www.philamassages.com/blog-1/it-band-syndrome-or-why-is-my-it-band-sore-and-what-can-i-do-about-it

 

References (viewed 3/5/18):

1. https://www.sports-health.com/blog/treadmill-workouts-what-runners-need-know

2. https://www.artofmanliness.com/2014/08/05/undo-the-damage-of-sitting/

3. https://www.livestrong.com/article/388802-treadmill-vs-running-outside/

4. https://www.huffingtonpost.com/rami-hashish/to-run-outside-or-on-a-treadmill_b_2553448.html

5. https://runnersconnect.net/treadmill-running-easier/

6. Active Isolated Stretching: The Mattes Method, Aaron L Mattes

7. Sport Stretch: 311 Stretches for 41 Sports, Michael J Alter

8. Trail Guide to the Body: 4th Edition, Andrew Biel

 

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2018

 

Effective stretching with PNF (Hamstrings, Hip Flexor Stretch)

Proprioceptive Neuromuscular Facilitation (PNF) stretches are a method of rapidly expanding range of motion. While originally designed for rehabilitation, they are now used by athletes and weekend warriors as well as studies show PNF stretches are one of the most effective stretching techniques if done twice a week [4].

Below is an overview of PNF and a demonstration on how to apply for increasing range of motion in the Hamstrings and Hip Flexors.

What is PNF?

It is a technique combining passive stretching and muscle contraction to achieve maximum flexibility. It can be done with a partner or on your own with assisted tools (such as therapy bands or stretch band ropes).

There are multiple techniques of PNF stretches:

1.     Hold/relax :

This technique relies on a muscle reflex called autogenic inhibition. During this process, the muscle auto-regulates after an increased contraction or stretch by reducing muscle excitability. In theory, this reflex allows the muscle to be stretched to protect itself from muscle tear [8].

  1. Put the muscle in a maximum stretch position (passive stretch) and hold for a few seconds.
  2. Contract the same muscle without moving (isometric contraction*) for 5-10 seconds.
  3. Relax the muscle, and increase the stretch again while exhaling. The second stretch should be deeper than the first.
  4. Repeat steps a., b., and c., several times until the soft tissue experiences a noticeable release.

*An isometric contraction occurs when no movement takes place/the muscle length does not change during contraction. For example, when pushing an immovable object [7].

2.     Contract/relax:

This technique also relies on autogenic inhibition.

  1. Put the muscle in a maximum stretch position (passive stretch) and hold for a few seconds.
  2. Contract the same muscle while moving (isotonic contraction**).
  3. Relax the muscle, and increase the stretch again while exhaling. The second stretch should be deeper than the first.
  4. Repeat steps a., b., and c. several times until the soft tissue experiences a noticeable release.

**An isotonic contraction occurs when a movement takes place while contracting a muscle. For example, lifting a dumbbell during a Biceps curl [7].

3.     Contract/hold:

This technique relies on a muscle reflex called reciprocal inhibition. During this process, the antagonist (opposing muscle) relaxes while the agonist (major muscle completing the movement) contracts [8]. For example, in doing a Biceps curl, the Biceps muscle contracts and shortens while the Triceps muscle relaxes and elongates.

  1. Put the muscle in a maximum stretch position (passive stretch) and hold for a few seconds.
  2. Contract the antagonist (opposite) muscle without moving (isometric contraction) for 5-10 seconds.
  3. Relax the muscle, and increase the stretch again while exhaling. The second stretch should be deeper than the first.
  4. Repeat steps a., b., and c. several times until the soft tissue experiences a noticeable release.

Most PNF Stretching techniques are usually assisted with a partner to achieve maximum flexibility and stability. However, there are few techniques that you can do by yourself. Below are a couple of demonstrations in stretching the Hamstrings and Hip Flexors that you can do at home. These muscles are often tight with endurance athletes as well as those who spend time driving or at a desk. You can add these stretches to your fitness routine to increase range of motion in the hips.

Hold/Relax for Hamstrings

  1. Lie on your back on the floor and use a strap or towel to hold one leg straight up to the sky. Extend the knee and flex the ankle the best you can.
  2. Use only about 25% of your strength as you push your heel towards the floor for 3-5 seconds in an isometric contraction.
  3. Relax for 5-10 second while pulling your foot toward you (stretching the Hamstrings).
  4. Repeat steps 1-3 until you stop feeling a release and lengthening throughout the backside of your legs and hips.
     

 

 

Contract/Hold for Hip Flexors

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  1. Position yourself in a half-kneeling position. You can hold a pole against the back of your torso to help stabilize your spine by bracing the abdominals and pressing your lower back into the pole.
  2. Afterwards, push your hips as far forward as possible while bracing your core.
  3. Next, activate the Glutes to push your hips forward even more for 5-15 seconds while exhaling.
  4. Hold the increased stretch position for 5-10 seconds the repeat steps 1-3 until you stop gaining range of motion.

 

 

 

 

PNF stretching is a great technique to increase range of motion for athletes. At Phila Massages, your therapists can include PNF in your session, as well as demonstrate PNF techniques for self-care.

References (viewed 12/6/17):

  1. http://www.philamassages.com/blog-1/use-it-or-lose-it-how-age-affects-flexibility?rq=static%20stretching
  2. Appleton, Brad. 2001. Stretching and Flexibility: Everything You Never Wanted To Know. Roots & Wings. Pp. 21
  3. https://www.healthline.com/health/fitness-exercise/pnf-stretching#pnf-techniques
  4. Proprioceptive neuromuscular facilitation stretching: mechanisms and clinical implications. Melanie J. Sharman, Andrew G. Cresswell, Stephan Riek. Sports Med. 2006; 36(11): 929–939.
  5. https://www.prehabexercises.com/the-art-of-stretching/
  6. http://link.springer.com/article/10.2165/00007256-200636110-00002
  7. http://web.mit.edu/tkd/stretch/stretching_2.html#SEC15
  8. http://coolefitness.com/blog/autogenic-inhibition/

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2018

Understanding Pain

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What is pain? Merriam-Webster defines pain as this: “Usually localized physical suffering associated with bodily disorder (such as a disease or an injury); also: a basic bodily sensation induced by a noxious stimulus, received by naked nerve endings, characterized by physical discomfort.” [1]

While pain was once classified as a sensation measuring the level of tissue damage, it is now accepted that pain is a “complex and highly sophisticated protective mechanism.”  So how does the body measure pain? While the body doesn’t exactly have “pain receptors” that immediately respond to pain, it does have a complicated network of specialized nerves called Nociceptors [2] that send signals to the brain warning of possible dangers like imbalances in homeostasis and sensation. These receptors send signals to the brain after said stimuli has passed a “high threshold” established by the nociceptors, once the threshold has been passed by a chemical, thermal or mechanical stimuli. The signals that they send to the brain are not exactly signals of‘pain’ because ‘pain’ is a sensation created in the brain (through the processing of large amounts of data and guided by factors like past experiences, expectation of pain and other sensory data) and sent to the areas of stimulation. The signal the brain sends back to the areas affected is the perception of pain. For example if one were to simultaneously grab onto a cold wire and a warm wire, the brain’s immediate reaction is “HOT!!’ and sends the message that it is a single burning hot wire in an attempt to protect the body from tissue damage. If the same person were to grab the wires individually the brain would respond accordingly, no longer receiving mixed signals and sending a signal of perceived pain.

PAIN IN SPORTS/MASSAGE

Many different forms of pain can be experienced in training and competition and those who experience it can also interpret it in many ways. For example a beginner athlete in weight lifting or running most likely has less of a tolerance for the sensations one might feel while training. A person new to weight lifting may take the burning of repetitions (positive training pain) as the sign of a problem (negative training pain), while a seasoned weightlifter would think nothing more of it than part of the process necessary to achieve hypertrophy. The same person could also mistake an actual injury as positive training pain when a veteran to lifting would recognize the sensation as a threat and react accordingly. Just as in sports, overtime one develops a sense of how a massage, intended to facilitate tissue recovery, should feel. A first time recipient of massage may be uncomfortable with the pressure that a veteran of massage may interpret as “too light”.  Recipients of massage both new and seasoned as well as the therapists they work with may find the use of a pain scale during massage to be very useful. It’s a good idea to incorporate a system of understanding in order to maximize client/therapist communication and achieve the greatest results.  Developing a pain scale such as the following could go a long way.

 [5]

[5]

In conclusion, the sensation of pain is both complex and relative and should be treated as such. Not all pain is bad pain, but all pain is the brain’s way of sending a signal of possible danger.

 

References (viewed 8/31/17):

  1. https://www.merriam-webster.com/dictionary/pain
  2. https://www.sciencedaily.com/terms/nociceptor.htm
  3. http://www.appliedsportpsych.org/resources/resources-for-athletes/pain-tolerance-in-sport/
  4. https://www.google.com/amp/www.bodyinmind.org/what-is-pain/amp/
  5. http://wellness.allinahealth.org/library/content/0/10

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2018

Self-care for your soles: stretching and massaging the feet

The dog days of summer are upon us, and for many of us that means our dogs are barking. Whether it’s long training runs or just running around town in flip-flops, summer activities can be hard on our feet. Feet are important - if your body was a house, the feet would be the foundation. Stiffness and pain in the feet can affect your stride, your posture, and even the long-term health of your knees and hips. Despite their importance, feet are all-too-often overlooked when it comes to our stretching and self-care routines. In this blog post, I will cover a number of ways to care for and protect our hard-working feet.

My foot care routine consists of three easy elements:

1.     Stretching the soles and tops of the feet

2.     Stretching the toes and mobilizing the ankles

3.     Rolling out the arches of the feet

 

Stretching the soles of the feet

This exercise calls for you to start on your hands and knees. Pad the knees with a folded blanket or towel, or do this exercise on a soft carpet.

Tuck your toes under so that the soles of your feet are pointed at the wall behind you.

Slowly and carefully sit back onto your heels, keeping the toes tucked. You should feel an intense stretch on the soles of the feet, and you may not be able to sit all the way up at first.

Take three deep breaths in this position, and then gently come back down onto hands and knees. Un-tuck your feet so that the tops of your feet are resting on the ground, and then sit up. This provides a stretch to the tops of the feet.

I recommend this stretch before and after a run, or just at the end of your day. It’s especially effective for anyone with plantar fasciitis and can be helpful as well for those with Achilles tendonitis or tight calves.

 

Stretching the toes and mobilizing the ankles

For this stretch, sit in a chair or on the floor with one foot crossed over the opposite knee. If you are sitting on the floor, you may want to sit on a folded blanket or towel to raise your seat up off the floor and protect your back.

Flex and spread the toes on your crossed-over foot, and then weave the fingers of your opposite hand in between your toes. This may feel like a stretch at first, especially if you wear close-toed shoes or heels regularly. Be patient and gentle, and only go as far as feels comfortable!

Use the hand that is grasping the foot to move the foot in circles at the ankle.Do five circles in one direction, and then reverse directions and do five more. You can give yourself a small massage while your hand is on your foot - I like to gently squeeze the toes, and to give some pressure to the spot on the inner arch of my foot.

Switch sides, and then you’re done! This stretch is super easy, but keeping the toes flexible and the ankles mobile is crucial for foot health and our overall stride and posture.

 

Rolling out the arches of the feet

Did you know that you can roll out your feet, the same way you might use a foam roller on your quads and back? All you need is a tool of the right size to fit your feet - some people use a tennis ball, a lacrosse ball, a special foot roller, or even a frozen water bottle! The frozen water bottle feels especially delicious after a long, hot run, and the cold helps to reduce swelling and pain.

So, there you have it! Three simple, easy practices to help you take care of the foundation of your body. You’re all set for a long walk on the beach (or your next half marathon)!

 

References

  1. http://www.shape.com/lifestyle/mind-and-body/must-do-foot-stretch-after-every-single-run
  2. http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/plantar-fasciitis/stretching-exercises-plantar-fasciitis
  3. http://www.ipfh.org/foot-care-essentials/why-preventive-foot-health-is-important

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2018

Weight-lifter’s Shoulder (Distal Clavicular Osteolysis) (Upper back, neck and chest self-massage and stretch)

Weight-lifter’s shoulder, or Distal Clavicular Osteolysis, is a painful shoulder injury that occurs when the distal end of the Clavicle beings to deteriorate. As the body attempts to heal itself, the surrounding area can become inflamed and fibrosis (scar tissue) can form. Untreated, the condition can cause degeneration of the AC joint.

After reviewing the basic anatomy of the shoulder, going over possible causes for this injury and the symptoms that can be found, the treatment recommendations will be reviewed, including how massage, self-massage and stretching can be included in the recovery process.

Shoulder anatomy

The shoulder is composed of 3 bones:

  • The Clavicle (or Collarbone) goes from the Sternum (or Breastbone) to the shoulder
  • The Scapula (or Shoulder blade) includes the Acromion (most lateral part, can be felt when touching the outermost and superior part of the shoulder), the Glenoid cavity (articulates with the Humerus) and the Coracoid process (under the Clavicle)
  • The Humerus, or upper arm bone

Several joints are involved in a healthy shoulder:

  • The Glenohumeral joint, between the Glenoid cavity and the Head of the Humerus
  • The Acromioclavicular joint (or AC joint), between the Acromion and the distal end of the Clavicle
  • The Scapulothoracic joint, where the Scapula glides on top of the Thorax, in the back
  • The Sternoclavicular joint, between the Breastbone and the Collarbone.

For Distal Clavicular Osteolysis, the areas affected are usually the distal part of the Clavicle and the AC joint, but other surrounding structures can be affected by the inflammation too. 

Cause

The deterioration is generally due to repetitive stress on the shoulder. Stress can come from over training or improper training involving excessive pull on the Clavicle. For example, doing bench presses where the elbow drops below the body can put excessive strain on the Clavicle.

Symptoms

Weightlifter’s shoulder causes sharp pain in the area of the AC joint. The pain increases during movements that involve the joint (bench press, push-ups, power clean, …), the evening after training, or when sleeping on that shoulder. 

Treatment

Non-surgical options:

  • Rest from the activities that affect the bone and/or modification of weight training techniques gives more time to the bone to heal, and could help it regenerate itself. Modification recommendations by a physical therapist can include:
    • Narrowing hand spacing on barbells
    • Ending bench presses 2 inches above the chest
  • Icing helps decrease inflammation and provides pain relief.
  • Taking anti-inflammatories (as advised by a doctor) can help for pain management.
  • Massage therapy can help reduce hypertonic muscles that might be adding strain to the shoulder structures and can help reduce pain from muscle guarding.

If non-surgical options are not successful, surgery options may be offered.  

Massage therapy for symptom relief

During a massage therapy session, the focus will be on the muscles attaching to the anatomical structures presented above. By reducing areas of hypertonicity, the stress on the bony structures is reduced as well and discomfort from tight muscles is decreased. Tight areas can be found in the Pectorals, the neck muscles or in the upper back and can be treated with techniques such as deep tissue and stretching. These areas can also be addressed at home with self-massage techniques involving a massage ball and stretching: some commonly used techniques are illustrated below.

The techniques presented can be used outside the context of injury to prevent excessive tightness and maintain shoulder range of motion. Include them in your training regimen as needed.

As always, make sure to see your doctor if you suspect you have a shoulder injury and before attempting any self-care exercises. 

Related article: What Exactly Is a Rotator Cuff? article + video

Sources

  1. A Patient’s Guide to Weightlifter's Shoulder (Distal Clavicular Osteolysis), Houston Methodist (http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/shoulder/weightlifters-shoulder/)
  2. Sports and Exercise Massage, 2nd Edition, by Sandy Fritz
  3. Anatomie de l’appareil locomoteur, member supérieur, Michel Dufour
  4. Anatomy Trains, Thomas W. Myers
  5. The Roll Model, Jill Miller

Images

  1. Shoulder anatomy: http://www.eorthopod.com/images/ContentImages/shoulder/shoulder_cuff_tear_arthropathy/shoulder_cuff_tear_arthropathy_anat03.jpg
  2. image of weightlifter: http://us.myprotein.com/thezone/wp-content/uploads//2016/08/shoulder-pain-after-bench-press-1.jpg

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2018

Assessing the Lower Half: Recognizing Muscular Imbalances Through Postural Assessments

Assessing someone’s posture could speak volumes. Proper postural alignment allows for optimal neuromuscular efficiency, which produces effective and safe movement. Good posture ensures the muscles of the body are in proper alignment and that there is proper absorption and distribution of forces throughout the kinetic chain. In other words, joint motion is happening the way it’s meant to, and less stress is being created. In general, when muscle imbalances are present, a certain muscle (or muscles) associated with a joint (or joints) may be in a shortened state while others are in a lengthened state, affecting the position of the joint and over time, create a cycle of injury, compensations and decreased mobility. When range of motion is lacking in certain joints, the body will try and find that range of motion somewhere else. In athletes who depend on core and lower body strength efficiency such as runners, any slight muscular imbalance could potentially lead to gait compensations, performance declinations, and injury later on. Other lifestyle factors to consider with muscular imbalances include past injuries, repetitive movements, extended periods of sitting, and occupational roles.

Though much could be said for assessing the head, neck, and shoulders, many athletes develop more lower body imbalances due to the constant loading and movement patterns required of them. Below are some basic static and dynamic tests that could be administered to detect any common postural distortion patterns including which muscles are either overactive (need to be released/stretched) or underactive (need to be strengthened) . Muscle groups that need to be strengthened should be addressed by the proper professionals such as a physical therapist or corrective exercise specialist, whereas overactive and tight areas will benefit most from frequent massage, stretching and foam rolling.

Static assessment side view

A. Lower Crossed Syndrome- anterior tilt of the pelvis (arched lower back)

  • Overactive Muscles: Hip Flexor Complex, Adductor Group (Groin Muscles), Latissimus Dorsi, Erector Spine
  • Underactive Muscles: Gluteus Maximus, Gluteus Medius, Transverse Abdominals

B. Proper alignment

Dynamic assessment front view: Overhead Squat

A. Pronation Distortion Syndrome- foot pronation (flat feet) and internally rotated knees (knee valgus)

  • Overactive Muscles: Gastrocnemius/Soleus (Calf Muscles), Peroneals, Adductors, TFL, Hip Flexor Complex
  • Underactive Muscles: Anterior Tibialis, Posterior Tibialis, Gluteus Maximus, Gluteus Medius

B. Proper alignment

Dynamic assessment side view: Overhead Squat

A. Excessive Forward Lean- tightness in the hip flexors and posterior legs cause weight to be shifted forward

  • Overactive Muscles: Gastrocnemius/Soleus (Calf Muscles), Hip Flexor Complex, Abdominals
  • Underactive Muscles: Anterior Tibialis, Gluteus Maximus, Erector Spine

B. Proper alignment

Full Range Of Motion (Or Are Your Joints Flexible Enough?)

Full range of motion is an integral factor in optimal performance. Studies have shown that performing exercises with full ROM is more beneficial for long term strength than performing the same exercises with a shortened ROM. Increased passive flexibility in joints has also been shown to delay the onset of arthritis, as well as reduce symptoms.

Each muscle group works in tandem to produce joint movements.  You have the agonist (performer of an action), antagonist (opposite muscle group, and stabilizer muscles) they stabilize the joint while it’s moving).   Imagine your running stride; your leg moves forward, your foot hits the ground, and you use that foot to launch your body forward. The first joint movement in this action is called hip flexion. Your hip flexors (the agonists) will lift your thigh forward and up, so that you can plant your foot forward. If the antagonist group (the hamstrings) has a pathologically shortened ROM, your hip flexors will not be strong enough to overpower them, and you will have a short stride. In order to prevent this, you will need to check your hamstring ROM and treat them accordingly. You can apply this thinking to any movement or exercise; your bench press, squat, deadlift, running, jumping, and throwing. There is always an agonist, and antagonist. Each group will need to utilize full ROM in order to perform optimally.

Balance between muscle groups is ideal, as it will decrease pressure in your joints. Each joint is surrounded by soft tissue. This can be muscle tissue, fascia, tendons and ligaments. If this tissue is tight, it will pull the joint into itself and, eventually, wear down the cartilage and synovial fluid. Over time, this can cause two bones to grind, which can lead to arthritis.  Keeping this surrounding tissue loose and soft will help prolong the health of your joints.

Each joint has a normal, ideal range of motion. Anything less than this normal range is termed “hypomobility” and will eventually cause some problems. Anything significantly higher than this normal range is termed “hypermobility” and will also, eventually, cause some problems. You’ll want to regularly test your ROM and keep each joint near this ideal range.  If you have some hypomobility in a certain movement, you will want to soften and loosen the antagonist group. If there is hypermobility in a movement, then you will want to strengthen and tighten the antagonist muscle group. Again, we just want a healthy balance between the groups.

Below is a somewhat comprehensive list of some main joints and movements. You will see what the ideal ROM is, as well as the antagonist and agonist for each movement. You can use this information as a comparison to your own ROM. Have a friend take a picture of you. You can then draw a line with a protractor and see how you match up!

Normal ROM (in degrees)

Hip and Leg

Hip

1.    Flexion 0-125

Agonists: Hip flexor group - Iliopsoas, TFL, Rectus Femoris, Pectineus, Sartorius.

Antagonists: Hamstrings, Gluteus Medius, Gluteus Maximus.

2.    Extension 0-30

Agonists: Hamstrings, Gluteus Medius, Gluteus Maximus.

Antagonists: Hip Flexor Group - Iliopsoas, TFL, Rectus Femoris, Pectineus, Sartorius.

3.    Adduction 45-0

Agonists: Adductor group - Pectineus, Adductor Brevis, Adductor Longus, Gracilis, Adductor Magnus.

Antagonists: Gluteus Minimus, Gluteus Maximus, Gluteus Medius, TFL.

4.    Abduction 0-45

Agonists: Gluteus Minimus, Gluteus Maximus, Gluteus Medius, TFL.

Antagonists: Adductor group - Pectineus, Adductor Brevis, Adductor Longus, Gracilis, Adductor Magnus.

5.    Medial (internal) rotation 0-45

Agonists: Adductor group, TFL.

Antagonists: Lateral rotator group - Piriformis, Gemellus Superior And Inferior, Obturator Internus And Externus, Quadratus Femoris. Iliopsoas.

6.    Lateral (external) rotation 0-45

Agonists: Lateral rotator group - Piriformis, Gemellus Superior And Inferior, Obturator Internus And Externus, Quadratus Femoris. Iliopsoas.

Antagonists: Adductor group, TFL.

Knee

1.    Flexion 0-130

Agonists: Hamstrings, Gastrocnemius.

Antagonists: Quads.

2.    Extension 0

Agonists: Quads

Antagonists: Hamstrings, Gastrocnemius.

Ankle

1.    Plantar flexion 0-50

Agonists: Gastrocnemius, Soleus.

Antagonists: Tibialis Anterior.

2.    Dorsiflexion 0-20

Agonist: Tibialis Anterior.

Antagonists: Gastrocnemius, Soleus.

3.    Inversion (supination) 0-35

Agonists: Tibialis Anterior, Tibialis Posterior.

Antagonists: Peroneus Longus, Peroneus Brevis, Peroneus Tertius.

4.    Eversion (pronation) 0-25

Agonists: Peroneus Longus, Peroneus Brevis, Peroneus Tertius.

Antagonists: Tibialis Anterior, Tibialis Posterior.

Shoulder and Arm

Shoulder

1.    Flexion 0-90

Agonists: Anterior Deltoid, Clavicular Head Of Pectoralis Major, Long Head Of Biceps.

Antagonists: Latissimus Dorsi, Teres Major, Posterior Deltoid, Long Head Of Triceps.

2.    Extension 0-50

Agonists: Latissumus Dorsi, Teres Major, Posterior Deltoid, Long Head Of Triceps.

Antagonists: Anterior Deltoid, Clavicular Head Of Pectoralis Major, Long Head Of Biceps.

3.    Abduction 0-90

Agonists: Deltoid, Supraspinatus.

Antagonists: Latissumus Dorsi, Teres Major, Pectoralis Major.

4.    Adduction 90-0

Agonists: Latissimus Dorsi, Teres Major, Pectoralis Major.

Antagonists: Deltoid, Supraspinatus.

Screen Shot 2017-05-10 at 9.09.29 AM.png

5.    Lateral (external) rotation 0-90

Agonists: Posterior Deltoid, Infraspinatus, Teres Minor.

Antagonists: Latissimus Dorsi, Teres Major, Subscapularis, Anterior Deltoid.

6.    Medial (internal) rotation 0-90

Agonists: Latissimus Dorsi, Teres Major, Subscapularis, Anterior Deltoid.

Antagonists: Posterior Deltoid, Infraspinatus, Teres Minor.

Elbow

1.    Flexion 0-160

Agonists: Brachialis, Biceps, Brachioradialis.

Antagonists: Triceps, Anconeus.

2.    Extension 0

Agonists: Triceps, Anconeus.

Antagonists: Brachialis, Biceps, Brachioradialis.

3.    Pronation 0-90

Agonists: Brachioradialis, Pronator Teres, Pronator Quadratus.

Antagonists: Biceps, Supinator, Brachioradialis.

4.    Supination 0-90

Agonists: Biceps, Supinator, Brachioradialis.

Antagonists: Brachioradialis, Pronator Teres, Pronator Quadratus.

Wrist

1.    Flexion 0-90

Agonists: Wrist flexor group.

Antagonists: Wrist extensor group.

2.    Extension 0-70

Agonists: Wrist extensor group.

Antagonists: Wrist flexor group.

3.    Adduction 0-65

Agonists: Extensor Carpi Ulnaris, Flexor Carpi Ulnaris.

Antagonists: Extensor Carpi Radialis Longus, Flexor Carpi Radialis, Abductor Pollicis Longus.

4.    Abduction 0-25

Agonists: Extensor Carpi Radialis Longus, Flexor Carpi Radialis, Abductor Pollicis Longus.

Antagonists: : Extensor Carpi Ulnaris, Flexor Carpi Ulnaris.

Neck and Spine

Neck

1.    Flexion 0-90

Agonists: Sternocleidomastoid, Scalenes, Longus Capitis, Longus Colli.

Antagonists: Upper Trapezius, Levator Scapula, Splenius Capitis, Splenius Cervicis.

2.    Extension 0-55

Agonists: Sternocleidomastoid, scalenes, longus capitis, longus colli.

Antagonists: Upper Trapezius, Levator Scapula, Splenius Capitis, Splenius Cervicis.

3.    Rotation (right and left) 70

Agonists: Upper Trapezius, Scalenes, Levator Scapula.

Antagonists: Contralateral Upper Trapezius, Scalenes, Levator Scapula.

4.    Lateral flexion 35

Agonists: Sternocleidomastoid Upper Trapezius, Scalenes, Levator Scapula.

Antagonists: Contralateral Sternocleidomastoid Upper Trapezius, Scalenes, Levator Scapula.

Spine

1.    Flexion 75

Agonists: Rectus Abdominus, Internal And External Obliques, Quadratus Lumborum.

Antagonists: Spinalis, Iliocostalis, Longissimus

2.    Extension 30

Agonists: Spinalis, Iliocostalis, Longissimus

Antagonists: Rectus Abdominus, Internal And External Obliques, Quadratus Lumborum.

References:

  1. "Physical Activity for Arthritis." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 18 Apr. 2017. Web. 25 Apr. 2017, from https://www.cdc.gov/arthritis/basics/physical-activity-overview.html
  2. "Normal Ranges of Joint Motion." STRETCHING AND FLEXIBILITY - Normal Ranges of Joint Motion. N.p., n.d. Web. 25 Apr. 2017, from http://web.mit.edu/tkd/stretch/stretching_8.html
  3. “Joint Range of Motion Testing” (n.d.). Retrieved April 25, 2017, from http://www.exrx.net/Testing/JointROM.html
  4. "Impact of Range of Motion During Ecologically Valid Resistance Training Protocols on Muscle Size, Subcutaneous Fat, and Strength", McMahon, Gerard E.1,2; Morse, Christopher I.1; Burden, Adrian1; Winwood, Keith1; Onambélé, Gladys L.1. Retrieved 26 April, 2017, from http://journals.lww.com/nsca-jscr/Citation/2014/01000/Impact_of_Range_of_Motion_During_Ecologically.32.aspx
  5. Fritz, Sandy . Sports & Exercise MassageComprehensive Care in Athletics, Fitness, & Rehabilitation. Elsevier Health Sciences, 2012. 
  6. Trail Guide to the BodyA Hands-On Guide to Locating Muscles, Bones and More. 2015. 
  7. W.Lowe, Whitney . Orthopedic MassageTheory and Technique. Elsevier Health Sciences, 2009. 
  8. G.Salvo, Susan. Massage TherapyPrinciples and Practice. Elsevier Health Sciences, 2015. 

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician

Copyright © Vidal Sports LLC 2018

Back Muscles: Structure, Strengthening and Stretching

Almost everybody has experienced back pain or tightness at one time or another.  Limited flexibility, chronic aches and time lost from work are some of the consequences of this ailment.  We strive to stay ahead of this disabling situation, but we are affected by it for a variety of reasons.    They may include weak muscles, muscular imbalance, over-exertion and fatigue. Our posture, range of movement and even our moods are affected by these limitations.  We will discuss the structure of the whole back muscles, both anatomically and functionally, though our focus will be on the mid and lower back. We will then provide a series of exercises for both strengthening and stretching the back muscles as a preventative measure for the future. These exercises are generally recommended, but please make sure to check with your physician before attempting them.

Structure

The back muscles are designed to direct various movements of the back (upper, mid and lower back), shoulders, neck and arms, provide protection of the spine and maintain an erect posture.  They can be divided into three groups, based on their location and associated movements. The Superficial group is located along the mid to upper back and include the Latissimus Dorsi, Trapezius, Levator Scapulae and Rhomboids (Major and Minor).  Their functions involve movements of the shoulders, scapula, arms and neck.  They can be viewed in Figure 1.  The Intermediate group includes the Serratus Posterior (Superior and Inferior).  They are associated with the movements of the rib cage.  The Deep group includes the Iliocostalis, Longissimus and Spinalis, collectively known as the Erector Spinae.  They are the longest muscles in the back and run parallel and on each side of the spine (from the sacrum to the cervical portion of the vertebrae). The Spinalis lies medial to the Longissimus and the Iliocostalis is the most lateral of the three muscles.  An illustration is provided in Figure 2. The function of the Erector Spinae is to extend, flex and laterally flex the vertebral column. Back pain tends to be located in the lower back region and these muscles need to be highlighted for strengthening and stretching  purposes.  

 Fig. 1

Fig. 1

 Fig. 2

Fig. 2

Strengthening exercises

A series of two strengthening exercises provided below illustrates some easy weight lifting or core strengthening movements.

Reverse Fly

Stand tall with feet shoulder width apart, back straight with knees slightly bent.  Hold a five to eight pound dumbbell in each hand, palms facing in and hinge forward at the waist.  Bend elbows slightly and raise the weights out to the side, as far as you can.  Return to starting position and repeat 2 sets of 16 reps. (Fig. 3)

 Fig. 3

Fig. 3

Opposite Arm and Leg Reach

Start on your hands and knees.  Reach your right hand forward while, at the same time stretching your left leg backward (and toes flexed).  Hold for 5 seconds then release and repeat using the opposing arm and leg.  Repeat this sequence 10 times. (Fig. 4)

 Fig. 4

Fig. 4

Stretching exercises

Knee to Chest

Intended to stretch the lower back and glutes.  Lie flat on your back and slowly bend your right knee, pulling your leg to your chest. Wrap your hands around your knee, holding that position for 20 seconds.  Return your leg to the starting position and repeat the sequence for each leg. (Fig. 5)

 Fig. 5

Fig. 5

Lumbar Traverse

This exercise is intended to stretch the Paraspinal muscles.  Lie flat on your back with legs extended.  Bend your right knee and cross it over the left side of your body.  Hold that pose for 20 seconds and return to starting position.  Repeat this sequence for each leg 3 times. (Fig. 6)

 Fig. 6

Fig. 6

Child’s Pose

This is a restful common pose in Yoga, meant to relax and decompress the lower back.  Position yourself on the floor on your hands and knees, with knees splayed outward (wider than hip distance apart).  Turn your feet inwards to touch and push your hips backward resting them on your heels.  Extend your arms forward and allow your head to fall forward in a relaxed manner.  Hold for 20 seconds and then return to starting position.  Repeat this sequence 3 times.  (Fig. 7)

 Fig. 7

Fig. 7

A regular routine of strengthening and stretching of the lower back muscles can help avoid back injury or alleviate the pain when it occurs.  It should not be a debilitating condition, though it is quite common.  Massage is a valuable resource to help in relieving hypertonic muscles, decrease pain and discomfort and also increase range of motion.  A massage session will often incorporate some of the stretches listed above, if applicable for your needs.  A massage therapist can assist you, to supplement the measures you may have already undertaken.

References:

  • Fig. 1: http://teachmeanatomy.info/back/muscles/superficial/ (viewed 4/3/17)
  • Fig. 2: https://www.pinterest.com/pin/343047696587939838/ (viewed 4/3/17)
  • Fig. 3: http://www.health.com/health/gallery/0,,20709957,00.html#reverse-fly-0 (viewed 4/12/17)
  • Fig. 4: http://www.health.com/health/gallery/0,,20709957,00.html#opposite-arm-and-leg-reach-0 (viewed 4/12/17)
  • Fig. 5, 6 & 7: http://www.apmhealth.com/education/healthy-living/stretching---strengthening-tips/6-stretches-to-help-back-pain (viewed 4/12/17)
  • http://teachmeanatomy.info/back/muscles/intrinsic/ (viewed 4/3/17)
  • http://anatomy.uams.edu/introback.html (viewed 4/12/17)
  • http://www.mayoclinic.org/diseases-conditions/back-pain/basics/prevention/con-20020797 (viewed 4/12/17)
  • http://anatomyzone.com/tutorials/musculoskeletal/extrinsic-muscles-of-the-back/ (viewed 4/12/17)
  • http://www.kingofthegym.com/back-anatomy (viewed 4/3/17)
  • http://www.spine-health.com/wellness/exercise/stretching-back-pain-relief (viewed 4/12/17)
  • http://www.sport-fitness-advisor.com/muscular-system-diagram.html (viewed 4/12/17)

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2018

Active Isolated Stretching (AIS)

Active Isolated Stretching is a stretching technique used by professional athletes and fitness coaches to increase flexibility and treat injuries.

Definition:

“Active”

The movement is initiated by the athlete then deepened by the therapist, to go beyond what the athlete would normally do on their own. The active participation favors muscle awareness and relaxation for more efficiency.

“Isolated”

Stretches isolate specific muscles for more precise work than general stretching (for example, there are 6 different stretches for the 6 muscles that comprise the hamstrings).

“Stretching”

The stretch allows for increased range of motion by lengthening muscles, fascia and increasing joint mobility.

Watch a slideshow of AIS.

How it works:

Stretches are held no more than 2 seconds, and repeated up to 10 times. After a session, the therapist teaches specific stretches for home self-care.

Benefits:

Stretching has many benefits:

  • Increases range of motion in those muscles that need more mobility thus reducing the risk of injury
  • Participates in the reduction of knots and muscle tightness, also reducing risks of injury
  • Provides more mobility, comfort and better posture, reduces asymmetries.

Watch our testimonial of a client who was helped in treating his IT Band syndrome with AIS.

All of our therapists have basic training in AIS and Nick is our certified AIS therapist – ask us about incorporating AIS to your next massage session. 

At the end of an AIS session, your therapist will demonstrate self-massage techniques to use at home to continue benefiting from the technique. 

Watch a hamstring self-stretching sequence with AIS

 

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2018

Achilles tendonitis (Calf Stretch)

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[1]

One of the largest and strongest tendons in the body is the Calcaneal tendon, better known as the Achilles tendon.  This tendon is responsible for helping you walk to work, run those long runs, and jump with during that HIIT workout. When you stand up on your toes or push off, this is the tendon that allows you to do so. It attaches from your calf muscles (Gastrocnemius and Soleus) to your heel (calcaneal bone) and is one hardworking tendon: when you flex your calf, it pulls on your heel. Overuse, poor self-care leading to tight muscles, poor shoe choices (not enough support, old, too high…), excessive incline workouts, increasing running mileage or the intensity of your workout too quickly are some of the things that can lead to pain and injury to the Achilles tendon. If left untreated, it can turn into what is known as Achilles tendonitis or tendinopathy. Symptoms of this injury are pain, swelling and inflammation in the back of the heel or lower calf; there may also be limited flexibility in the ankle. This can be felt especially in the morning when first walking, but can be present throughout the day with varying degrees of pain and discomfort.

If these symptoms start and don’t dissipate, stop your workouts immediately. Any activity that aggravates your symptoms should be put on hold until this injury subsides. Until you can complete toe raises without pain, don’t resume intense activities. The RICE method is recommended (Rest, Ice, Compression and Elevation) right after the injury occurs. Your doctor will generally recommend Ibuprofen to reduce the pain and inflammation. Splints and or taping can also be beneficial. A visit to the doctor for proper diagnosis is also important.

Once through the initial acute phase, low impact activities such as the elliptical, swimming and biking can help resume activities without being too stressful on the lower leg. Gentle stretching, foam rolling and massage of the calves are great ways to loosen the muscles in the lower legs and reduce the stress on the Achilles tendon.

Some stretches that have been shown to be beneficial are eccentric heel drop, Soleus stretch and Gastrocnemius stretch, shown below.

Eccentric heel drop:

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[2]

Stand on the edge of a step and lower yourself slowly and in control (try a slow count of 4 or 5) on your injured foot, essentially exerting force as the muscle extends.

Then use your other, non-injured, foot to raise yourself back up, so as not to stress the tendon in the rising motion.

Do 15 repetitions, twice a day.

[3]
[3]

Soleus stretch

With your knees bent, and the leg that needs to be streched behind gently lean forward while keeping the rear heel down.

Do 15 repetitions, hold each for 15-20 seconds.  Repeat twice a day.

Gastrocnemius stretch

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[3]

With straight legs and the leg that needs to be stretched behind, gently lean forward while keeping the heel down.

Do 15 repetitions, hold for 15-20 seconds each.  Repeat twice a day.

If these methods don’t alleviate the problem, your doctor can recommend the next steps.  Self-care should be an important part of every person’s routine, especially athletes.  With proper self-care of your lower legs, stretching, listening to your body, foam rolling and massage, you can aim to stay healthy and injury free.

Picture references:

  1. http://strengthrunning.com/2013/03/achilles-tendonitis/
  2. http://www.runnersworld.co.za/training/cross-training/dont-get-hurt-build-strength/
  3. http://astepahead.com.au/cooling-down-and-stretching-for-netball/

References (viewed 2/27/17):

  1. http://www.healthline.com/health/achilles-tendinitis
  2. http://orthoinfo.aaos.org/topic.cfm?topic=a00147
  3. http://www.runnersworld.com/achilles-tendinitis
  4. http://www.sportsinjuryclinic.net/sport-injuries/ankle-achilles-shin-pain/achilles-tendonitis
  5. http://www.webmd.com/fitness-exercise/picture-of-the-achilles-tendon#1

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2018

Sinus Inflammation and Massage

This time of year we are exposed to all sorts of nasties, which can leave our sinuses in overdrive. Changes in temperature, environmental allergies and illnesses can all contribute to sinus inflammation. If you are one who suffers from sinus inflammation, you will know that it can be difficult to function normally when symptoms rear their ugly heads! Sinuses are air-filled sacs that clean the air that we breathe through the nose. They lighten the bones of the skill, and provide shape to the face. Allergies, infections and physical obstructions can cause the sinuses become inflamed or swollen. (1)

Structure

There are four sinus points located above, either side of, and behind the nose. The sinuses are named after the bones of the skull in which they are located (2).

image [2]
image [2]

Frontal Sinuses: located on the center of the forehead above the brow-line of each eye, on the frontal bone

Ethmoid Sinuses: small air sacs located on either side of the bridge of the nose. The Ethmoid bone separates the nasal cavity from the brain

Sphenoid Sinuses: located deep to the nose, near the optic nerve on the Sphenoid bone

Maxillary Sinuses: located behind the cheekbones near the Maxilla or upper jaw

image [1]
image [1]

Causes of sinus inflammation

  • Viruses, bacteria and fungi: cold or flu
  • Structural problems: deviated septum, nasal polyps can obstruct the flow of mucus and block drainage (3)
  • Environmental irritants: indoor and outdoor pollutants, grasses and pollens, certain foods

Symptoms

  • Headaches
  • Tenderness in the affected area
  • Swelling and puffiness around the eyes
  • Runny or congested nose
  • Facial or tooth pain
  • Fatigue

Massage

When inflammation occurs, pain may also be present in the surrounding muscles of the face, the upper neck and the jaw. In structural and environmental cases of sinus inflammation, gentle massage around the face and neck will help to drain the sinuses and relieve pressure from the affected areas.

If a fever and infection is present, massage can exasperate symptoms. In this case it is best to wait until the fever has passed before bodywork is performed. (1)

See our article on ‘Cold, Flu and Massage’.

Self care massage for sinus relief

  1. Set yourself up in a comfortable position, preferably supporting your head and neck.
  2. Spread your fingers wide, place your fingers and thumbs around your scalp line and gently move your fingers in small circles
  3. Have your fingers meet in the center of your forehead, slowly drag your fingertips towards each ear (frontal sinus)
  4. Take your index or middle finger and slowly draw small circles along your eyebrow line, starting from your nose and gently migrating laterally towards each ear (frontal sinus)
  5. Bring your middle fingers back to the bridge of your nose. Find two little nodules, where your nasal bone meets the frontal bone. Hold a firm pressure for 10-15 seconds. (Ethmoid sinus)
  6. Move your fingers back to the bridge of your nose. This time, drag your fingers down each side of your nose (sphenoid sinus)
  7. Take a flat finger on either side of your nose, and gently drag along each cheek bone towards your ears (maxillary sinus)
  8. Small circles on the temporalis, (clench the jaw to locate the temporalis muscle)
  9. Firm pressure on the temporalis, slowly push your fingers away from your face (towards the back of your head) as you slowly open your mouth
  10. Small circles around the ear, (TMJ, Coracoid process and temporalis tendon)
  11. Gently pull your ears for a temporalis release

References:

  1. A Massage Therapist’s Guide to Pathology Ruth Werner LMP, NCTMB, fifth edition, pg. 332
  2. http://www.healthline.com/human-body-maps/sinus-cavities
  3. A Massage Therapist’s Guide to Pathology Ruth Werner LMP, NCTMB, fifth edition, pg. 333

Images:

  1. http://philschatz.com/anatomy-book/contents/m46355.html
  2. http://www.rugusavay.com/information-on-skull-anatomy-and-functions/

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2018

Take a deep breath and improve your athletic performance

Do you want to shorten recovery time, increase stamina, decrease stress, sharpen your focus, and improve your athletic performance? Take a deep breath and read on! As athletes, the importance of breathing is often overlooked. After all, everyone breathes all day every day, so why think about it? This blog post will explore some breathing techniques to help elevate performance, discuss the benefits that one can obtain by using those techniques and how massage can participate in more efficient breathing.

Recent studies have shown diaphragmatic and nasal breathing techniques could improve athletic performance. Diaphragmatic breathing may increase the antioxidant defense status in athletes after exhaustive exercise [1], activate the parasympathetic nervous system to calm nerves, decrease stress and muscle tension [2], sharpen focus, reduce fatigue, and promote stamina [3]. Nasal breathing on the other hand allows the body to take in and process oxygen 20% more efficiently during exercise and protects the lungs from cold and polluted air.For athletes specifically, these two techniques could increase physical performance, focus, mental performance and shorten recovery time [4]. In the video below we will teach you these two techniques so you can improve your breathing and athletic performance.

So where does massage come into play when it comes to breathing? Most people know that the lungs allow us to breathe but don’t usually think about the muscles that allow the lungs to function. The diaphragm is the main muscle that allows humans to inhale (inspiratory) and the abdominal muscles primarily allow humans to exhale (expiratory). A number of smaller muscles also assist in breathing as seen in the diagram below. Any restrictions we have in these muscles can impede breathing and thus harm athletic performance and recovery. Asking your massage therapist to incorporate techniques that target these muscles in your sessions can help to remove those restrictions and allow more effective and efficient breathing for improved performance.

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The Importance of SI Joint Function (SI Joint Dysfunction, SI Joint stretch)

What is the SI Joint?The sacroiliac joint or SI joint is the joint that connects the sacrum with the pelvis and is located on each side of the lower spine.

Ref. 1
Ref. 1

The SI joint’s main job is shock absorption.  It does this by transferring the forces of the upper body to the lower body, which includes the hips.  This is a very stable joint due to its anatomical configuration and strong ligaments. There are also strong muscles surrounding or reinforcing the joint such as erector spinae, psoas, quadratus lumborum, piriformis, abdominal obliques, gluteal muscles, and hamstrings which all make it even more stable.  

Despite being so stable the SI joint is in fact a mobile joint, though minimally, which allows it to perform proper shock absorption during weight-bearing activities and motions.  We will get to this in a moment.

Why Is This Joint So Important?

The most pivotal responsibility of the SI joint is to limit stress and force between the hip and lumbar spine.  It does this by anatomical configuration and its shear strength.  This comes to play in many daily situations such as standing, walking, sitting, lifting heavy objects, or exercises such as performing squats and jumping activities.  

SI Joint Dysfunction

Now that you have learned a little about the SI joint and its significance, it is just as important to know what happens when it is not functioning properly.  

SI joint dysfunction is one of the leading causes of low back pain.  It is often hard to diagnose initially because the symptoms are similar to sciatica or lumbar disc herniation, but it is usually found during  physical examination that includes movements.  Inflammation at the joints is also common in SI joint dysfunction.  The causes of SI joint dysfunction, however, are varied but fall into the category of hypermobility (instability) or hypomobility (stiffness).  This goes back to an earlier point, which is in order for proper shock absorption, the joint needs to stay mobile but can not become overly mobile to the point of instability.  

Symptoms include: pain on one side (more common) or both sides of the body, pain in the lower back and/or hip, pain in the thigh and/or glute, pain that radiates down the sciatic nerve (similar to sciatica), groin pain, and is most common among young and middle-aged women.  It can cause painful sitting and difficulty getting out of bed or car without experiencing pain.

How to Prevent or Treat Dysfunction

In order to prevent SI joint dysfunction from occurring, it is important to know the causes of instability or stiffness.  In most cases, the cause is due to muscle imbalances.  These muscle imbalances can include weak glutes, hips, hamstrings, core, and lats.  Not only is hip strength and stability  important, but also mobility.  Other causes are poor posture such as leaning more to one side, running which creates a repetitive pounding on the joint, repetitive or violent twisting motions, and pregnancy due to hormones being released in the body that cause your joints to become more mobile and loose.  If chronic back pain occurs it is always important to find the cause and location before any specific treatment is to be performed.  

Now that you know you have SI joint dysfunction, how do you fix it?  The combination of massage, stretching, and exercise techniques are effective ways to treat this.  The role of a licensed massage therapist would be to increase mobility in the areas of tightness that are causing the SI joint to become stiff, one of the two main causes of SI joint dysfunction.  They would be targeting the  imbalanced muscles previously talked about while also increasing blood flow to the joint to promote healing.  Your LMT may also recommend stretching for self care in conjunction to your sessions.  Here are two examples of stretches:

1 - Prone on elbows

With this stretch you want to make sure your elbows are aligned with your shoulders and tilt up with your palms until you feel it in your lower back

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2 -single knee chest stretch

With this stretch you simply want to extend the opposite leg and bring the other leg to your chest and hold.  You could also use shorter holds and alternate which turns this into more of an exercise/dynamic stretch.

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If you have never had SI joint dysfunction or have had it and do not want a relapse, adding strength training to your massage and stretching routine is key. The 3 areas that you would focus on are:

1 - Glute strengthening and activation exercises (see Ref. 2 for an example)

2 - Hip strengthening exercises (see Ref. 3 for an example - Make sure your back stays straight and head and feet are facing forward) 

3- Core strengthening exercises. A good example is a forearm plank (see Ref. 4); although basic, it is a very effective exercise to strengthen your core. Make sure you are contracting your abs and lifting from the toes. Hold for about 60 seconds or as long as you can during each rep. 

There are also several other exercises that you can do at home to address the SI joint.  See Ref. 5 for a video demonstrating 3 common exercises.

Lastly, use proper posture and focus on sitting properly, making sure in particular that you are not leaning on one side more than the other, and practice self-awareness.

References (retrieved 10/28/16):

  1. http://www.blackchiropractic.com.au/chiropractic/sacroiliac-joint-pain/
  2. https://youtu.be/rrZRGk2YeWM
  3. https://youtu.be/_OQi0XkgZss
  4. https://s-media-cache-ak0.pinimg.com/564x/6c/9f/d3/6c9fd3dd4a6e9f55eb7b806fa150717a.jpg
  5. https://www.youtube.com/watch?v=CXH5SEI_AsM
  6. https://breakingmuscle.com/mobility-recovery/why-your-si-joint-is-such-a-pain-and-4-exercises-to-fix-it-0
  7. http://www.spine-health.com/conditions/spine-anatomy/sacroiliac-joint-anatomy
  8. http://www.spine-health.com/conditions/sacroiliac-joint-dysfunction/sacroiliac-joint-dysfunction-si-joint-pain
  9. http://www.webmd.com/back-pain/si-joint-back-pain
  10. http://www.stack.com/a/7-exercises-to-build-complete-hip-strength

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2018

Runners keep your BALANCE in check!

If you are a runner and are work with me, you may notice me asking you many questions during our session.  This is because I want to be sure you are doing everything possible to prevent muscular imbalance and injury.  It seems runners just want to run, however, let’s face it, you must do your homework as well.  Balance and lower leg/foot strength ( along with massage and foam rolling) are some of the key ingredients to improving AND keeping muscle tissue healthy.  Runners who have an impaired sense of balance are at an increased risk of injury by tripping and falling, says Kevin McGuinness at Washington Orthopedics & Sports Medicine.  If you have an impaired sense of balance or compensation due to overuse it may cause injury. If you are having issues simply balancing on one leg while just standing, imagine how much more difficult it is on your body while bounding from one leg to the next! Need to be further convinced to improve your balance?  Here are 4 reasons:

  1. Who doesn't want Herculean ankle strength?!
  2. It will also improve your sense of awareness and proprioception.
  3. It will improve your single leg balance (aka run).
  4. This does not require much equipment, if any.

Some ideas for strengthening feet for balance:

  1. Ditch your shoes. Start by walking around your house barefoot, and once you gain strength there then work your way up to some barefoot exercises.
  2. Running in sand to work through joint articulation in the feet and increase strength and flexibility.
  3. Walking on rocks. This will get the proprioceptive nerves in your feet going and will help prevent back pain.
  4. Roll out the three arches of your foot. You can use a lacrosse ball frozen water bottle etc. Here be sure to include your lateral (outside) arch, transverse (center) arch, and medial (inside) arch. You will most likely feel pain in your transverse arch taking extra care when you move close to the heel as this area may be very sensitive.
  5. Use balance boards, bands and balance trainers. The picture below is an example of an exercise I recommend frequently to my running clients for muscular balance in the lower leg. You may also place your ankles on a foam roller or a throw pillow to lift your heels off of the ground.  Attach the other end of the band to heavy furniture or weights or have someone stand on it.
ref. 5
ref. 5

Since running involves dynamic movement it makes sense for us to improve our dynamic balance training.  Check out these videos below for some examples of dynamic balance training that requires absolutely no equipment:

    1. This exercise may prove to be tougher than it looks for some.  Try to keep control on one leg and stabilize the foot, ankle, knee and hip while drawing the letters of the alphabet A all the way through Z by dynamically moving the arms.
  1. If you have mastered the previous exercise then you may want to attempt the single leg “hop and “hold” for more difficult single leg dynamic stability.

You will find that this article will provide you with many additional ideas for exercises to improve run strength.  This includes improving optimal power, core strength, lateral movement, upper body strength, leg strength, stabilization and posture.

Focusing on some of the exercises presented above a few times per week in addition to your runs will aid in injury prevention, keep muscle tissue healthy and will even improve overall strength and the quality of your runs. If you are looking for any additional ideas for balance exercises I am happy to share more of them with you during our next massage therapy session.  Stay balanced!!!

References (Retrieved 10/4/16)

  1. http://greatist.com/move/balance-training-for-runners
  2. http://www.runningshoesguru.com/2014/05/dynamic-balance-training-for-runners/
  3. https://www.washingtonpost.com/lifestyle/wellness/why-balance-can-make-or-break-a-runner/2016/03/23/4a9df378-ec69-11e5-b0fd-073d5930a7b7_story.html
  4. http://www.bodybuilding.com/fun/strength-training-for-runners-how-to-do-it-right.html
  5. https://breakingmuscle.com/strength-conditioning/5-foot-strengthening-exercises-to-improve-speed-power-and-balance

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2018

Two Minutes A Day For A Healthier Spine

Spinal hygiene is often compared to dental hygiene. Similar to teeth, the spine can develop disorders and deteriorate. The  only difference is that if there is dysfunction or decay, it is more difficult to replace the spine than it is to install dentures in someone's mouth. The spine protects the nervous system in the body and the nervous system controls every function in the body. For example, the nervous system tells the body to breathe and it tells the heart to beat which are both vital functions to sustain human life. They also tell the muscle fibers when to fire during movement and when to relax when not moving. Spinal Hygiene Exercises are important because they help prevent spinal dysfunction.  When practiced daily these exercises improves posture, repairs and maintains muscular strength, range of motion, and encourages a healthy nervous system. In fact, a study measuring the quality of life (a health-related concept) concludes that spinal hygiene exercises improves the quality of life (Shepard 1).

Spinal hygiene exercises should be done daily as part of a morning and/or evening routine. When practicing spinal hygiene exercises maintain an even breathing pattern, go as far as the body will allow, and notice the body's posture.  Are the shoulders elevated? Is the head in a forward position? Is the pelvis tilted forward? Are the knees extended? Become aware of the body and make necessary adjustments whether you are walking, running, sitting, or standing.

Spinal Hygiene Exercises (TWY)

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T- Hold arms out with palms up. Squeeze shoulder blades (contracting rhomboid muscles) for 10 seconds. Relax shoulder blades while arms are still out. Repeat 3 times.

W- hold arms out with palms up. Bend arms at the elbows at 90 degrees. Squeeze shoulder blades (contracting rhomboid muscles) for 10 seconds. Relax shoulder blades while arms are still up. Repeat 3 times.

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Y- Hold arms up in the air with thumbs back, palms facing each other. Squeeze shoulder blades (contracting rhomboid muscles) for 10 seconds. Relax shoulder blades while arms are still up. Repeat 3 times.

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Sleep It On, Don’t Sleep On It (Best Sleep Positions)

Sleep: The Benefits

Sleep can be your muscles greatest training ally. True rest can be the most beneficial thing in a persons training regimen because the body actually builds muscle while you sleep. As the body falls deeper and deeper into sleep, passing from a state of beta rhythm (conscious alert state) through alpha and theta, to delta rhythm (deep sleep/ REM sleep state) the brain signals the paralysis of the skeletal muscles and the pituitary gland secrets the peptide hormone Somatotropin (Also known as growth hormone).

The Hormone Behind the Muscle Building

Somatotropin stimulates muscle growth, cell reproduction and cell regeneration. Essentially, using this hormone, muscles broken down through training are rebuilt and improved. Somatotropin is found in its highest levels in the body during delta rhythm sleep. Therefore an athlete is not optimizing training/recovery without getting optimal sleep.

Lack Of Sleep: The Drawbacks

Sleep or lack there of can also be very detrimental to the body, without the signals from the brain to paralyze the muscles into a complete resting state, the body would continue to break down further due to the muscles reaction to the stimuli of the dreams experienced during sleep. This may occur due to noise pollution in an individual's sleeping environment and or poor sleeping habits, which leads to the question 'which is the best position in which to get a good, restful, muscle repairing nights sleep?'

The answer to that question may not be the most simple. Every sleeping position has its pros and cons.

Positions: Pros and Cons

For instance those who prefer to sleep on their Back benefit from the alignment of the spine and neck while at the same time they are putting pressure on the lordoses of the neck and lower back and the muscles that support them in addition, they are at a higher risk from respiratory restriction or sleep apnea. One solution to this problem is to discontinue the use of a traditional pillow; this forces the head to tilt back allowing the respiratory tract to remain fully open like in the use of CPR.

Areas under pressure and fixes: